Document Detail

Are double-blind food challenges necessary before starting an elimination diet?
MedLine Citation:
PMID:  1959769     Owner:  NLM     Status:  MEDLINE    
Food allergy is normally treated by eliminating the offending food. Such a measure, however, may cause nutritional and sociopsychological problems, so an allergy must be diagnosed with the utmost certainty. To date the most reliable diagnostic test is the double-blind food challenge (DBFC). The rationale for using this test is the marked difference in positive results with open and double-blind food challenges. Only about 30% of open challenges that appear positive are confirmed on blind challenge. There is ample evidence, too, that a negative DBFC may in fact indicate tolerance to that food. From the literature it appears that almost all patients who reintroduced a certain food into their diet after a DBFC had given negative findings did not present any adverse reaction to it. In our caselist of 21 patients with probable reactions to foods but negative DBFC, 19 (90.5%) tolerated the "incriminated" food well when it was reintroduced into their diet even in unlimited amounts. Only two (9.5%) again presented symptoms when they started taking large amounts of the problem food. Therefore, one precaution recommended before reintroducing a food item into a patient's diet after a negative DBFC is to check how it is tolerated at high doses. A review of the literature confirms the unquestioned utility of the DBFC. Nevertheless, in some situations this test is not indicated. The main one, of course, is in patients with life-threatening symptoms such as anaphylactic shock or glottis edema, in whom any provocation test is contraindicated.(ABSTRACT TRUNCATED AT 250 WORDS)
E A Pastorello; V Pravettoni; L Stocchi; A Bigi; M L Schilke; C Zanussi
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Allergy proceedings : the official journal of regional and state allergy societies     Volume:  12     ISSN:  1046-9354     ISO Abbreviation:  Allergy Proc     Publication Date:    1991 Sep-Oct
Date Detail:
Created Date:  1992-01-08     Completed Date:  1992-01-08     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8902396     Medline TA:  Allergy Proc     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  319-25     Citation Subset:  IM    
Department of Internal Medicine, University of Milan, School of Medicine, Italy.
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MeSH Terms
Double-Blind Method
Food Hypersensitivity / diagnosis*,  psychology,  therapy

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